New research addresses the social determinants of health

Researchers are looking at the impacts of the social determinants of health and how they are mitigated in various programs across the country. The social determinants of health are the economic and social conditions that affect people’s health, and three recent studies that examine their impact were published in this month’s issue of Health Affairs.

In 2013, Maryland’s Health Enterprise Zone Initiative was implemented to improve access to care in economically disadvantaged communities with poor health outcomes. A study conducted by Darrell J. Gaskin and colleagues found that the initiative correlated with a reduction of 18,562 inpatient stays and an increase of 40,488 emergency room visits from 2013 to 2016. The researchers concluded that the net cost from the reduction of inpatient stays outweighed the initiative’s cost to the state.

Another study looked at a program for adults receiving care at Eskenazi Health, a county-owned health system in Indianapolis, Indiana, that provides “wraparound services,” including behavioral health, social work, dietetics, and patient navigation, co-located with primary care services. The study conducted by Joshua Vest and colleagues found a 7% reduction in hospitalizations and 5% reduction in emergency department visits in the year following receipt of any wraparound service. The study estimates a cost savings of $1.4 million annually from potentially avoided hospitalizations.

A third study examined a nonprofit, community-based program in Queens, New York, that provides social services, including wellness programs, psychological assessments, and chronic disease education, to residents of affordable senior housing apartments. Compared to the residents who did not receive such services, Michael Gusmano and colleagues found those served had 32% lower hospital discharge rates, one-day-shorter hospital length of stays, and a 30% lower rate of hospital discharge for ambulatory care-sensitive conditions.